How to Protect Your Kidneys   (January 24, 2007)

It is very clear that following a strict set of guidelines can help protect kidney function in people with diabetes who have been told that they have diabetic kidney disease. The list of advice includes:

• Strict control of any tendency towards hypertension. The blood pressure should be kept well under the usual guideline of 140 (systolic) over 90 (diastolic). If you have diabetes and your blood pressure is 130/80 or more, you should make the lifestyle changes, as well as take medication to lower your blood pressure. Having a blood pressure of less than 120/80 is best, but any decrease in blood pressure if it is high will help.
  
  
• Use of a type of prescription medication for hypertension that's in either of two classes; one class is called an "ACE-inhibitor" and the other “ARB”. Probably all the drugs in these two classes work about the same to protect the kidneys.
  
  
• Use of a modified meal plan, with a fairly small amount of protein. A Registered Dietitian should be consulted to develop a workable meal plan for people with the dual disorders of diabetes and kidney disease.
  
  
• Avoidance of certain medications that aggrevate kidney disorders. The list to avoid includes some over-the-counter pain medications such as ibuprofen (Motrin and others) and Alleve, but does not include aspirin and Tylenol (acetominophen). Certain prescription drugs that are used for the treatment of arthritis and pain, called "non-steroidal anti-inflammatory drugs" (NSAID's) are all to be avoided.
  
  
• Avoidance of dehydration. If there's vomiting or severe diarrhea, go to an Emergency Room or other facility, and get "tanked up" with intravenous fluids. You'll feel much better, and avoid any risk of kidney shutdown from dehydration.
  
  
• Avoidance of X-rays that involve the injection into your blood vessels of liquids called "radioopaque contrast agents" (a frequent slang term for these agents is "X-ray dyes") unless there's a nephrologist (kidney specialist) assisting with the case. These contrast agents are eliminated from the body through the kidneys, and can clog up the kidneys if there's already some kidney damage.
  
  
• Prompt treatment of any problems with urination, such as painful urination or blood in the urine.
  
  
• Cessation of smoking.
  
  
• Control of blood sugar level.
  
  
• Referral to a nephrologist (kidney specialist) for additional advice when the urine protein level exceeds 1000 mg (the normal amount should be below 150) or the creatinine level in the blood is over 3.0 (creatinine normally should be below 1.5), or upon the request of the patient.

This is now a standard list of recommendations that should increase the time between the initial diagnosis of diabetic kidney damage, and the possibility of dialysis, transplant, or death. So, if you've been told you have an increased risk of diabetic kidney disease (officially called diabetic nephropathy), discuss these recommendations with your physician.